From the 2009 UCSF Diabetes Update and Advances in Endocrinology and Metabolism meeting.

Some recent reports from major trials and long-term follow-up of large diabetes treatment studies have sparked a lot of discussion about how low to try and push hemoglobin A1c levels in people with diabetes. Clinicians may be wondering whether intensive glucose control is safe and worth the effort, and in which patients, after tasting the alphabet soup of recent findings — from the 10-year follow-up of the UKPDS to the ACCORD and ADVANCE studies, the VADT, and Steno-2, plus the 2009 joint statement on all this from the American Diabetes Association, American Heart Assocation, and American College of Cardiology.

Dr. Elizabeth Murphy, chief of endocrinology at San Francisco General Hospital, put it all in perspective. What to do differently? Not much. Aim for a hemoglobin A1c level below 7% for most patients. Consider lower targets for younger, healthier, newly diagnosed patients. Consider higher targets if the patient is expected to live less than 5 years, or has severe hypoglycemia, advanced complications, or other significant comorbid conditions. The American Association of Clinical Endocrinologists still recommends A1c targets below 6.5%, she added.